12 Fla. L. Weekly Supp. 673b
Insurance — Personal injury protection — Demand letter — Document identified as demand letter with attached HCFA forms fails to comply with requirement to specify exact amount due as it does not account for amounts applied to deductible, amounts reduced to reasonable charges or any other partial payments made
URGENT CARE CENTER (a/a/o Esperanza Vargas), Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County, Civil Division. Case No. 04-16726 SP 05 (04). April 15, 2005. Catherine M. Pooler, Judge. Counsel: Michael I. Libman, for Plaintiff. Lynne M. French, Adams, Blackwell & Diaco, P.A., Tampa, for Defendant.
ORDER ON DEFENDANT’S MOTION FOR PARTIAL SUMMARY JUDGMENT
THIS CAUSE having come before this Honorable Court on March 21, 2005, upon Defendant’s Motion for Partial Summary Judgment, and the Court having heard argument of counsel, having reviewed the file herein and being otherwise fully advised in the premises, it is hereupon,
ORDERED AND ADJUDGED:
1. There are no genuine issues of material facts in dispute in that the facts presented by Defendant in its Motion for Partial Summary Judgment and its Affidavit in Support of Defendant’s Motion for Summary Judgment are uncontested. Plaintiff filed no contravening affidavit.
2. The demand letter submitted by the Plaintiff has failed to state the exact amount claimed. Section 627.736(11) F.S. (2003) is very specific regarding the requirements of the Demand Letter and what is expected from both sides in order to comply with the statute.
3. Statute §627.736 states, in pertinent part:
(11) DEMAND LETTER. —
(a) As a condition precedent to filing any action for benefits under this section, the insurer must be provided with written notice of an intent to initiate litigation. Such notice may not be sent until the claim is overdue, including any additional time the insurer has to pay the claim pursuant to paragraph (4)(b).
(b) The notice required shall state that it is a “demand letter under s. 627.736(11)” and shall state with specificity:
3. To the extent applicable, the name of any medical provider who rendered to an insured the treatment, services, accommodations, or supplies that form the basis of such claim; and an itemized statement specifying each exact amount, the date of treatment, service, or accommodation, and the type of benefit claimed to be due. A completed form satisfying the requirements of paragraph (5)(d) or the lost-wage statement previously submitted may be used as the itemized statement.
. . .
(d) If, within 15 days after receipt of notice by the insurer, the overdue claim specified in the notice is paid by the insurer together with applicable interest and a penalty of 10 percent of the overdue amount paid by the insurer, subject to a maximum penalty of $250, no action may be brought against the insurer. . . . [emphasis added]
4. The requirements of §627.736(11) F.S. (2003) are very specific and are designed, in part, to give the insurer an opportunity to know from the Demand Letter the exact amount of the overdue claim and to avoid litigation by paying the exact amount of the “overdue claim specified in the notice”, as specified in §627.736(11)(d) F.S. (2003).
5. Plaintiff simply attached HCFA forms to a document identified to be a Presuit Demand Letter pursuant to §627.736(11) without identifying the exact amount claimed to be overdue.
6. This Court finds persuasive Chiro-Medical Rehabilitation of Orlando, Inc. a/a/o Paul Scott v. Progressive Express Insurance Company, 12 Fla. L. Weekly Supp.162b (Broward County, October 2004) and Universal Health Care Center, Inc., (a/a/o Texsenia Cross) v. Progressive Express Insurance Company, 11 Fla. L. Weekly Supp. 932b (Broward County, July 2004).
7. Merely attaching HCFAs to the Demand Letter does not provide the insurer with the “exact amount due” as this does not account for the amounts applied to the deductible, amounts reduced to reasonable charges or any other partial payments made.
8. Therefore, it is the determination of this Court that Plaintiff’s Demand Letter fails to comply with the requirements of §627.736(11) F.S. (2003) as a matter of law.
9. Accordingly, Defendant’s Motion for Partial Summary Judgment be and the same is GRANTED.
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